Active NPI
Shonda Shanelle Waller, PHARM.D.
- Pharmacist
- Palatka, FL
National Provider Identifier
1174932636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS52379
- Practice address
- 1302 River St
Palatka, FL 32177-5042 - Phone
- (386) 328-0558
- NPI assigned
- Aug 10, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS52379 | FL | Primary |
Addresses
Primary practice location
1302 River St
Palatka, FL 32177-5042
Mailing address
PO Box 8600
Fleming Island, FL 32006-0014
Phone (302) 983-7404
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS52379 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670198400000",
"number": "1174932636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8600",
"city": "FLEMING ISLAND",
"state": "FL",
"postal_code": "320060014",
"telephone_number": "302-983-7404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1302 RIVER ST",
"city": "PALATKA",
"state": "FL",
"postal_code": "321775042",
"telephone_number": "386-328-0558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "SHONDA",
"middle_name": "SHANELLE",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-10",
"last_updated": "2022-12-05",
"certification_date": "2022-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS52379",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palatka, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.